• Clinics in Shoulder and Elbow
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• v.7 no.2
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• pp.76-82
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• 2004

Purpose: In the traumatic anterior shoulder instability, the laxity of joint capsule and ligament is frequently demonstrated. Although a arthroscopic procedure to address anterior instability with joint capsular redundancy have generally provided good results, its recurrence rate is higher than open procedure. By reducing the capsular redundancy, thermal shrinkage is likely to improve the outcome of arthroscopic anterior stabilization. The objective of this study was to evaluate additional thermal capsular shrinkage as a treatment of joint capsular redundancy in anterior shoulder instability. Materials and Methods: From March 1999 to June 2000, 25 shoulders of 23 patients of recurrent anterior shoulder dislocation underwent arthroscopic Bankart repair with shrinkage procedure. The mean follow up was 29 months and average age at the time of operation was 26 years. Of these patients, 20 were male and 3 were female who had been experienced the average 8 times of dislocation before operation. Thermal shrinkage alone without Bankart repair was performed in two cases who did not have Bankart lesion. The clinical result was evaluated in according to Modified Rowe Score. Results: The Modified Rowe Score was improved from preoperative 35 points to postoperative 88 points. None of cases showed recurrence of dislocation. But, in two cases, temporary sensory hypesthesia of the axillary nerve was developed and in two cases of postoperative stiffness, arthroscopic capsular release and brisement were performed. Conclusion: Additional capsular shrinkage in arthroscopic technique to address recurrent anterior shoulder instability could treat effectively the capsular redundancy.

• Journal of the Korean Arthroscopy Society
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• v.10 no.2
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• pp.135-140
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• 2006

Diagnosis and treatment of the unstable shoulder is one of the more difficult problems in orthopaedic surgery. There is confusion between the normal laxity with translation and subluxation of the humeral head relative to the glenoid and an abnormal amount of laxity, leading to pain and dysfunction. Unfortunately, there is no single treatment that applied to all lesions that cause the instability. It is imperative, therefore, that an accurate diagnosis be made, including the directions and degree of shoulder instability as well as any coexisting problems. Anatomical defects must be defined. Common factors that could most readily compromised instability repair are examined. These include techniques for making an accurate diagnosis with identification of the precise anatomical pathology, and the rationale for appropriate surgical treatment with the avoidance of technical complication such as unnecessary hardware or exposures that might lead to residual instability, arthritis, and nerve or vascular injuries. Additional injuries may be prevented by careful rehabilitation postoperatively to restore shoulder stability, flexibility, and endurance prior to an individual's return to stressful sports or work.

• Clinics in Shoulder and Elbow
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• v.3 no.1
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• pp.1-9
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• 2000

Purpose: To report the mid-term results of the inferior capsular shift procedure for the multidirectional instability, and to analyze whether the bilateral laxity, the generalized ligamentous laxity and the voluntary instability can influence upon the final outcome. Material and Method: We reviewed 95 patients with 96 shoulders treated by the inferior capsular shift procedure for multidirectional instability through an anterior approach. In total, 49 shoulders(51%) showed generalized ligamentous laxity, 56 shoulders(58%) bilateral laxity, and 65 shoulders(68%) voluntary subluxation. Mean follow-up was 27 months(11-60 months). Result: The final Rowe score was 75 points in patients who had had at least one of the bilateral laxity, generalized ligamentous laxity, or the voluntary subluxation and 84 points without any of these in each element. Seventy-five percent of the bilateral laxity and 87% of the unilateral instability continued to function well without any pain and instability postoperatively. Those with a voluntary(74%), those with an involuntary instability(83%), those with a generalized ligamentous laxity(73%) and without laxity(84%) could do well a daily living activity without instability Eighty-six percent who had had the voluntary instability was eliminated completely the voluntability. Eighty-four percent of the patients stated that they were subjectively satisfied with the status of their shoulder. Nine shoulders(9.4%) had recurrence of symptomatic and disabling instability and theses patients had had at least voluntary instability preoperatively. Seven patients(7.3%) suffered from the stiff shoulder after the inferior capsular shift procedure. Conclusion: The inferior capsular shift procedure in multidirectional instability provided satisfactory results both in objective and subjective terms. Nonetheless, a patient who has a bilateral laxity, a generalized ligamentous laxity or a voluntary instability could be expected less favorable results compared to those with neither of these. A careful selection of the inferior capsular shift procedure for the multidirectional instability is needed before surgery. But our results suggests that a voluntary instability is not always poor candidate for the inferior capsular shift procedure.

• Clinics in Shoulder and Elbow
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• v.23 no.2
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• pp.62-70
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• 2020

Background: Recent studies have reported high rates of recurrence of shoulder instability in patients with glenoid bone defects greater than 20% after capsulolabral reconstruction. The purpose of the present study was to evaluate the failure rate of arthroscopic capsulolabral reconstruction for the treatment of anterior instability in the presence of glenoid bone deficits >20%. Methods: Retrospective analyses were conducted among cases with anterior shoulder instability and glenoid bone defects of >20% that were treated by arthroscopic capsulolabral reconstruction with a minimum 2-year follow-up (30 cases). We included the following variables: age, bone defect size, instability severity index score (ISIS), on-/off-track assessment, incidence recurrent instability, and return to sports. Results: The mean glenoid bone defect size was 25.8%±4.2% (range, 20.4%-37.2%), and 18 cases (60%) had defects of >25%. Bony Bankart lesions were identified in 11 cases (36.7%). Eleven cases (36.7%) had ISIS scores >6 points and 21 cases (70%) had off-track lesions. No cases of recurrent instability were identified over a mean follow-up of 39.9 months (range, 24-86 months), but a sense of subluxation was reported by three patients. Return to sports at the preinjury level was possible in 24 cases (80%), and the average satisfaction rating was 92%. Conclusions: Arthroscopic soft tissue reconstruction was successful for treating anterior shoulder instability among patients with glenoid bone defects >20%, even enabling return to sports. Future studies should focus on determining the range of bone defect sizes that can be successfully managed by soft tissue repair.

• The Academic Congress of Korean Shoulder and Elbow Society
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• 2009.03a
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• pp.21-21
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• 2009

There are some patients who have traumatic anterior shoulder instability due to minor injuries like overhead activities. The purpose of this study was to clarify characteristic features of traumatic anterior shoulder instability due to minor injuries. According to the mechanism of injury in an initial dislocation, 83 shoulders that underwent the stabilizing surgery for traumatic anterior shoulder instability were divided into two groups. Traumatic group included patients who suffered from a fall or a direct injury. Minor injury group included patients who suffered from the other injury like overhead activity. General joint laxity, range of motion and laxity under anesthesia, and intraarticular findings were compared between two groups. The morphology of superior and middle glenohumeral ligaments, Bankart lesion, Hill-Sachs lesion, and partial articular surface tendon avulsion lesion were observed in arthroscopy. Minor injury group consisted of 19 shoulders with 8 males, 11 females and the mean age of 22.5 years. Traumatic group consisted of 64 shoulders with 52 males, 7 females and the mean age of 24.3 years. Female in minor injury group was significantly more than that in traumatic group. There was no difference in general joint laxity and intraarticular findings between two groups. Range of external rotation in injured side in minor injury group was significantly more than that in traumatic group. Inferior laxity in both sides in minor injury group was more than that in traumatic group. In conclusion, the traumatic anterior shoulder instability due to minor injuries might incline to occur the shoulder in female and with inferior laxity of shoulder.

• Journal of the Korea Convergence Society
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• v.12 no.10
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• pp.277-286
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• 2021

This study investigated the effect of a 12-week rehabilitation program on the range of motion (ROM) and muscle strength of high school baseball players with shoulder instability. We allocated 12 players with shoulder instability to the rehabilitation group and 13 players without shoulder instability to the normal exercise group. Covariate analysis (ANCOVA) was performed to assess the ROM of the internal (IR) and external (ER) rotational joints before and after participating in the 12 weeks of rehabilitation, and two-way ANOVA was performed to assess isokinetic muscle strength. The statistical significance level was set at p<.05. The IR ROM of the dominant (D) shoulder with instability and non-dominant (ND) shoulder was significantly increased before and after the rehabilitation program. The total ROM of the D shoulder with instability significantly increased after rehabilitation. IR isokinetic strength significantly improved at an angular velocity of 180°/s after rehabilitation. These results indicate that the rehabilitation program used in this study could be effective in improving ROM and muscle strength in patients with shoulder instability. However, due to the limited results, additional research on the premise of extending the rehabilitation period is necessary.

• Korean Journal of Radiology
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• v.20 no.6
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• pp.931-938
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• 2019

Objective: To compare inferior capsular redundancy by using magnetic resonance arthrography (MRA) images in patients with multidirectional instability (MDI) of the shoulder and control subjects without instability and thereby develop a screening method to identify the presence of shoulder MDI. Materials and Methods: The MRA images of patients with MDI of the shoulder (n = 65, 57 men, 8 women; mean age, 24.5 years; age range, 18-42 years) treated over an eight-year period were retrospectively reviewed; a control group (n = 65, 57 men, 8 women; mean age, 27.4 years; age range, 18-45 years) without instability was also selected. The inferior capsular redundancy was measured using a new method we named the glenocapsular (GC) ratio method. MRA images of both groups were randomly mixed together, and two orthopedic surgeon reviewers measured the cross-sectional areas (CSAs) and sagittal capsule-head ratios on oblique sagittal images, as well as the axial capsule-head ratios on axial images and GC ratios on oblique coronal images. Results: The CSAs and GC ratios were significantly higher in patients than in controls (both, p < 0.001); however, the sagittal capsule-head ratios and axial capsule-head ratios were not significantly different (p = 0.317, p = 0.053, respectively). In addition, GC ratios determined the presence of MDI more sensitively and specifically than did CSAs. A GC ratio of > 1.42 was found to be most suggestive of MDI of the shoulder, owing to its high sensitivity (92.3%) and specificity (89.2%). Conclusion: GC ratio can be easily measured and used to accurately screen for MDI of the shoulder.

• The Academic Congress of Korean Shoulder and Elbow Society
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• 2007.03a
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• pp.17-17
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• 2007

• Clinics in Shoulder and Elbow
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• v.27 no.2
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• pp.254-262
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• 2024

Several surgical procedures have been proposed to address anterior glenohumeral instability, which is one of the most common complaints in the general population. The remplissage, first described in early 2000s, is a procedure performed simultaneously with the arthroscopic Bankart repair to correct large, engaging Hill-Sachs lesions (HSLs). This procedure stabilizes the joint by tenodesing the infraspinatus tendon into the HSL to fill and disengage the defect. This procedure gained popularity because it has relatively low risk and is able to improve shoulder stability while being less invasive than other bone-blocking procedures. The remplissage has become a valuable add-on technique that can substantially improve outcomes in unstable patients undergoing arthroscopic Bankart repair. Nevertheless, several studies in the literature have raised concerns regarding its efficacy in critically unstable patients and the potential range of motion limitations that can arise postoperatively. Additional comparative studies and trials should be conducted to appropriately establish the role of remplissage in treating anterior instability, especially in patients with critical bone loss.

• Clinics in Shoulder and Elbow
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• v.2 no.1
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• pp.53-59
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• 1999

Initial treatment of multidirectional instability of the shoulder would be a thorough rehabilitation program. If rehabilitation fails to resolve a patient's symptoms, the most commonly performed surgical procedure remains the inferior capsular shift. Eleven patients who had disabling multidirectional instability of the shoulder were managed with the inferior capsular shift. All of the procedure were performed by means of an anterior approach and a laterally based capsular shift. All of the patients were the contact athletes. The purpose of our study was to evaluate the efficacy of the inferior capsular shift procedure in the contact athletic patients, to review the loss of external rotation postoperatively and to discuss their return to sports. Mean follow up duration was 14.5 months(range, 12 to 24). Pain was relieved postoperatively in all cases and most patients could get stability except one case of recurrent subluxation. The average loss of external rotation and forward flexion after the operation were Y and 30 at last follow up. By the rating scale from American Shoulder and Elbow Society, overall scores improved from 49 points to 85 points. The results were excellent or good in 9 patients(82%) out of 11 patients. In reference to return to sports, 10 patients(91 %) of 11 patients returned to their sports with 7 patients (64%) returning at the same levels of competitiveness. The inferior capsular shift procedure was considered to be a recommendable method for the management of the multidirectional instability of the shoulder.